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Table 1 Characteristics of 4 patients diagnosed with previously unknown AI among women with adrenal hypoandrogenemia*

From: The importance of adrenal hypoandrogenism in infertile women with low functional ovarian reserve: a case study of associated adrenal insufficiency

Patient

Age (years)

Diagnoses

Laboratory

Final diagnosis

Primary

Other

Immune

FSH (mIU/ML)

AMH (ng/mL)

Androgens

ACTH (pg/mL)

Cortisol (ug/dL)

1

28

POI1

Hypothyroid

+TPO2

30.0

3.04

TT 7.0 ng/dL

464.7

8.8

Primary AI

+ TG3

14.4

2.12

TT ud6

Celiac

+ DG4

DHEA ud

+ TG5

DHEAS ud

2

30

PCOS

SLE7

 

8.0

2.68

FT 0.4 pg/mL

**

 

Likely iatrogenic AI

HNA8

TT 17.0 ng/dL

DHEA 273.0 ng/dL

DHEAS ud

***

4.11

TT 30.0 ng/dL

DHEA 272.0ug/dL

3

30

   

7.7

ud

DHEAS 70.0ug/dL

ud

1.4

Secondary AI as part of pan- hypo-pituitarism

8.7

ud

FT 1.4 pg.mL

 

1.7

TT 14.0 ng/dL

DHEAS 56ug/dL

4

46

 

Crohn’s

 

12.5

ud

TT ud

ud

1.4

Secondary AI

Hypothyroid

FT ud

DHEA 117.0ug/dL

DHEAS 13.0ug/dL

  1. 1 POI primary ovarian insufficiency; 2 TPO thyroid peroxidase antibody; 3 TG thyroglobulin antibody; 4 DG deamidated gliadin antibody (IgA); 5 TG t-transglutaminase (igA) antibody; 6 ud undetectable; 7 SLE systemic lupus erythematosus treated with 7 mg prednisone p.o. o.d.; 8 HNA non-heredetary angioedema
  2. *Only 14 of 29 women identified in the center’s research database with adrenal hypoandrogenemia have so far been investigated in follow up
  3. ** Not obtained since patients received long-term prednisone
  4. *** Androgens and AMH level after supplementation with DHEA
  5. Patient 1: Upon diagnosis with PAI, the patient initiated supplementation with hydrocortisone, and continued her supplementation with levothyroxine. Though this patient presented to our center with a diagnosis of POI, her FSH values did not support this diagnosis but a diagnosis of oPOI/POA
  6. Patient 2: This patient consulted long-distance with our center after a spontaneous pregnancy loss in a spontaneously conceived pregnancy and after an IVF cycle suggestive of PCOS (29 oocytes), but with only 2 poor-quality embryos. After low androgens were noted, we recommended supplementation with DHEA 25 mg p.o., t.i.d. Androgen levels improved, as did her AMH, and the patient spontaneously conceived what was diagnosed as an ectopic pregnancy. We suspect this to represent a case of iatrogenic (tertiary) AI, secondary to prolonged prednisone supplementation
  7. Patient 3: This patient presented to our center since us of a gestational carrier had been recommended to her elsewhere
  8. Patient 4: This patient presented with primary infertility and Crohn’s disease, treated with Enbrel® (etanercept)
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Reproductive Biology and Endocrinology

ISSN: 1477-7827

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